[Isolated splenic metastasis in a case of adenocarcinoma of the uterine cervix. A clinical case]. / Metastasi splenica isolata in un caso di adenocarcinoma del collo uterino. Caso clinico.

The incidence of splenic metastasis, revealed during autopsy, from solid tumours varies from 1.6% to 30% with a mean of 7%. The clinical observation of splenic metastasis in patients with carcinoma of the exocervix is only occasionally reported. In the majority of cases metastasis appears 4 or 5 years after the onset of disease. The case reported here is the only example we have found in the literature relating to an adenocarcinoma of the uterine cervix which led to an isolated splenic metastasis. A 47-years-old patient underwent radical hysterectomy according to Meigs due to a stage 1B N0 G2 endocervical adenocarcinoma. The patient was subsequently reoperated due to pelvic recurrence and received radiotherapy. Almost five years after the first operation CT showed a suspected isolate splenic recidivation following pain in the left side. Hepatosplenic scintigraphy confirmed the presence of a large central cold area, with blurred edges, suggesting metastasis. The patient again underwent laparotomy: the volume of the spleen was found to be increased with the splenic hilum covered with neoplastic tissue. Splenectomy was performed. Abdomino-pelvic and retroperitoneal inspection showed no further signs of metastasis. Histological tests confirmed the massive metastasis of the adenocarcinoma in splenic parenchymal tissue which was relatively differentiated with a clear cell appearance. Seven months later the patient was again operated following intestinal occlusion due to numerous entero-enteric adhesions. During the course of surgery a micronodule was removed from the cholecystic serosa, apparently composed of fibrin; histological analysis proved that this micronodule was the site of glandular micrometastasis. The patient then began three cycles of chemotherapy with Adriamycin (60 mg/m2).(ABSTRACT TRUNCATED AT 250 WORDS)

[Computerized tomography in the staging of carcinoma of the oropharynx, the tongue and the mouth floor]. / La tomografia computerizzata nella stadiazione dei carcinomi dell'orofaringe, della lingua e del pavimento orale.

Eighty-seven patients with carcinoma of oropharynx, tongue and floor of the mouth were examined by means of CT; (TNM criteria); tumor staging was reviewed and compared with that obtained by clinical examination, by endoscopy, at surgery and histology. CT proved to be a reliable technique to detect both the presence of neoplasms, with the exception of very superficial ones, and their deep spread to parapharyngeal space, to muscles of floor of the mouth and prevertebral pterygoid muscles. Lymph node metastases, especially to retropharyngeal nodes, were also clearly demonstrated on CT scans, which indicates this technique as the examination of choice in oropharyngeal and oral cavity tumor staging, for it yields valuable information which can integrate clinical findings.

[Usefulness of computerized tomography in the prognosis of subarachnoid hemorrhage]. / Utilità della tomografia computerizzata nella prognosi delle morragie subaracnoidee.

The authors reviewed the computed tomographic (CT) scans of 129 patients with subarachnoid hemorrhage (SAH). The close correlation is stressed between the severity of the symptoms onset and the amount of blood demonstrated on CT scans. The importance is confirmed of CT in the prognostic evaluation of SAH. As a matter of fact, CT findings define the location and the amount of blood: these factors are closely related to the occurrence of vasospasms -i.e., the primary cause of death and poor outcome. CT also shows the possible complications (hematoma, hydrocephalus, mass effect) that, when present, have a negative impact on prognosis, independent of the neurologic condition. Finally, the authors point out how a reliable prognosis of SAH is based upon combined clinical evaluation and CT study.

[CT in hepatic injuries]. / La TC nei traumi epatici.

Twenty-one patients with hepatic injuries from blunt abdominal trauma were examined by Computed Tomography (CT). CT findings were correlated with those of plain X-ray films (5), radionuclide scanning (5), US (8), angiography (2), and with the findings of laparoscopy (2), exploratory laparotomy (6), and autopsy (2). CT well defines entity and severity of hepatic injuries, easily distinguishing minor from major ones. Moreover CT, by allowing the measurement of attenuation values, allows the various components of traumatic lesions (blood, clots, necrosis) to be recognized. CT is also useful in monitoring the healing patterns and in following the patients for late complications--e.g., abscess and biloma. After comparing it with other radiological investigation techniques, the authors emphasize the role of CT in defining both type and severity of liver injuries and in helping choose the better therapeutic approach (surgical or conservative). Thanks to its short execution time, to its reproducibility and to its allowing the contemporaneous evaluation of intra- and retroperitoneal organs. CT has become the radiological technique of choice in the patients with liver injuries.

Computerized axial tomography in calcaneal fractures.

The authors illustrate how CAT may be used to obtain a clear picture of fractures of the calcaneus. The first CAT pictures are evaluated at the acute stage with reference to the principal etiopathogenetic theories. Next, the outcome of fractures treated non surgically is evaluated. Lastly, we discuss the outcome of fractures which, on the basis of information provided by CAT, were treated by surgical reduction.

Efficacy of hepatic computed tomography to detect iron overload in chronic hemodialysis.

The diagnostic efficacy of hepatic computed tomography density (HCTD) in comparison with serum ferritin for the detection of iron overload was investigated in uremic patients on maintenance hemodialysis (HD) and in patients with idiopathic hemochromatosis (IHC). Ten IHC patients, 38 HD patients and 40 healthy subjects underwent the CT scanning of the liver and determination of percent saturation of transferrin, serum ferritin concentration and HLA typing. Liver iron content was determined by histochemical grading and direct measurement of liver iron concentration either in IHC patients or in HD patients. Nineteen HD patients were considered to have iron overload on the basis of liver iron concentration exceeding 3.6 mumol/100 mg dry weight. The mean +/- SD values of HCTD in healthy subjects, IHC patients, HD patients with iron overload and without iron overload were 60.2 +/- 5.6, 79 +/- 5.6, 71.4 +/- 3.6, 58 +/- 3.8 Hounsfield units, respectively. HCTD showed positive correlations with liver iron concentration and serum ferritin either in IHC patients or in HD patients. The analysis of the diagnostic efficacy of HCTD in comparison with serum ferritin for the detection of excessive hepatic iron in HD patients demonstrated that HCTD had higher sensitivity, specificity, positive and negative predictive values. Cut-off points were arbitrarily fixed to 66 Hounsfield units for HCTD, 400 micrograms/liter for serum ferritin and 3.6 mumol/100 mg dry weight for liver iron concentration. Seventeen HD patients who possessed the histocompatibility antigens associated with IHC, namely HLA-A3 and/or HLA-B7 and/or HLA-B14, had liver iron concentration, serum ferritin and HCTD values higher than those of the HD patients without these "hemochromatosis alleles".(ABSTRACT TRUNCATED AT 250 WORDS)

CT scan in a study of the normal anatomy of the hindfoot and midfoot.

The authors use CT scan to describe the anatomy of the hindfoot and midfoot. Initially the bones and related joints are examined, the latter being particularly complex and difficult to evaluate in this area with traditional radiology. Particular emphasis is placed on the description of the subtalar joint complex, to which all the bones of the hindfoot and midfoot contribute with the exception of the cuneiforms. This is followed by a description of the anatomical features of the soft tissues. The components of the five areas into which the hindfoot and midfoot may be subdivided are illustrated, with particular emphasis on the structures of the medial region which contribute to the formation of the tarsal tunnel. Starting from a description of the anatomy of this area, the main neurovascular trunks, the fascial structures, ligaments and muscles in the various sites are defined.

T staging of the laryngohypopharyngeal carcinoma. A 7-year multidisciplinary experience.

Sixty-six whole-organ sectioned, nonirradiated, laryngopharyngectomy specimens that were removed because of cancer during a 7-year period were uniformly examined to determine the accuracy of perioperative T staging by high-resolution computed tomography (CT) and clinical evaluation (indirect-direct laryngoscopy) by comparing this preoperative staging with the postsurgical pathologic staging. The accuracy of the clinical vs CT staging for laryngeal carcinomas was 58.8% vs 70.6%, whereas the accuracy of the staging by combination of the two modalities was 88.2%. Combined staging modalities showed the same accuracy for laryngeal and hypopharyngeal carcinomas (88.2%), whereas clinical staging accuracy for hypopharyngeal carcinomas was lower (52.9%) and CT accuracy was higher (82.4%) than that observed for laryngeal carcinomas. In the majority of the cases that were staged inaccurately, the error was one of under-estimation: in particular, tumors confined to the mucosa and early infiltration of laryngeal fat spaces were not detected by CT.

Ethmoidal meningioma revealed by transient global amnesia.

A patient in whom transient global amnesia (TGA) led to the diagnosis of an ethmoidal meningioma is described. One year after neurosurgery, the patient showed an impairment of long-term memory, without any clinical or neuroradiological sign of relapse. We suggest that TGA may express a preexisting subclinical impairment of memory neuronal systems.

Pathologic assessment of computerized tomography accuracy for the evaluation of the laryngeal cartilaginous framework in laryngopharyngeal carcinomas.

Sixty-six whole-organ sectioned laryngopharyngectomy specimens removed for cancer during a seven-year period were uniformly examined to determine the accuracy of preoperative high resolution computerized tomography (CT) for detection of cartilaginous involvement. Our results indicate that CT has a high overall specificity (88.2%) but a low sensitivity (47.1%); we observed a high false-negative rate (26.5%) and a fairly low false-positive rate (5.9%). Massive cartilage destruction was easily assessed by CT, whereas both small macroscopic and microscopic neoplastic foci of cartilaginous invasion were missed on CT scans. Moreover, false-positive cases were mainly due to proximity of the tumor to the cartilage. Clinical implications of these results are discussed.

Superficial extending carcinoma of the larynx.

Superficial extending carcinoma of the hypopharynx is a recently recognized form of carcinoma regarded as a possible pharyngeal counterpart to early gastric cancer and superficial esophageal carcinoma. In this study we report the radiological, clinical, and pathological features of three carcinomas of the larynx, which show architectural and histopathological features similar to those previously described in superficial extending carcinoma of the hypopharynx. These cases were singled out from a series of 37 consecutive laryngectomy specimens of primary infiltrating laryngeal carcinomas that were uniformly studied by means of a whole-organ sections technique. Pathologically, these cases showed a clearly invasive growth through the basal membrane into the lamina propria and an entire or predominant, extensive, superficial type of spread; infiltration of underlying muscle or gland structures was restricted to a few microscopic foci, regardless of the presence of lymph node metastases. The present study demonstrates that infiltrating carcinomas with a preferential superficial type of growth may also be encountered in the larynx. Differences between the histological features of these carcinomas of the larynx and the histopathological spectrum of so-called early laryngeal cancer are emphasized.

[Computerized tomography in renal injuries]. / La tomografia computerizzata (TC) nei traumi renali.

CT scans were performed on 25 patients suspected of sustaining renal trauma. The utility of CT in both detecting renal damage and appraising the gravity of injuries was assessed. Nowadays, in fact, nephrectomy is reserved for lesions devastating the kidney parenchyma or rupturing the renal pedicle; so it is very important to identify both the kind of lesions, and the extent of the damage, for the purposes of a better planned therapeutic approach. CT does both, being more accurate than urography in the detection of renal fractures, intra or extraparenchymal hematomas and contrast media extravasation. Urography very often shows aspecific lesion patterns and sometimes it is also falsely negative. In the present series CT was more reliable than angiography itself, particularly in the diagnosis of extra-renal hematic collections, contrast media extravasation and injuries to the other abdominal organs. Although CT may arouse the suspicion of and sometimes correctly diagnose vascular lesions, such as renal infarction, angiography remains the choice examination in the study of vascular lesions, thanks to its characteristic and unmistakable images.

[Role of computerized tomography in the TNM staging of laryngeal and hypopharyngeal neoplasms]. / Ruolo della tomografia computerizzata nella stadiazione TNM delle neoplasie laringee ed ipofaringee.

70 patients with squamous cell carcinoma of larynx and hypopharynx were examined by computed tomography; the TNM staging of tumors by CT, by endoscopy and by surgical operation was reviewed. CT proved to be reliable both to recognize the presence of neoplasms, with the exception of those very superficial, and their deep spreading to pre-epiglottic and para-laryngeal spaces, to the soft tissues of the neck and to the cartilages. Therefore CT is the examination of choice in laryngeal neoplasms staging, because it precisely completes the clinical and endoscopical informations.

Transient global amnesia.

30 patients aged between 45 and 78 years and who had suffered from transient global amnesia (TGA), were seen at the Department of Neurology, Pordenone Public Hospital, in the period 1978 to 1982. 25 patients had one or more risk factors for cerebrovascular disease, such as hypertension, cardiac abnormalities, diabetes and hyperlipidemia. EEG examination revealed abnormal activity only in 7 patients. Brain Computed Tomography showed cerebral atrophy in 10 and hypodense lesions in 3 patients. 16 patients had been followed up for a mean interval of 20 months. During the follow-up period, 4 patients had recurrent TGA and one had a transient ischemic attack in the vertebrobasilar arterial system. In the follow-up group, 15 patients showed permanent memory impairment. The high incidence of risk factors for cerebrovascular disease seems to confirm that TGA is probably due to transient cerebral ischemia. The high rate of permanent memory impairment, almost always connected with the coexistence of cerebrovascular risk factors, is not in agreement with the postulated good prognosis of TGA.

[Computerized tomography in cerebellar atrophy]. / La tomografia computerizzata nelle atrofie cerebellari.

Among 5680 patients who had CT cranial scans at the Radiological Service of the Hospital of Pordenone we selected by their histories and clinical findings and CT images 31 patients showing the signs of a cerebellar atrophic process. We compared CT scans with clinical symptoms; we found a correlation in 71% among CT abnormalities and clinical findings; in 22.5% CT showed an infratentorial atrophy, but clinical symptoms were absent; in 6.5% the CT scans were normal, although was present a cerebellar syndrome. We conclude that CT is an important and significative method in the diagnosis of posterior fossa degeneration, taking so the place of pneumoencephalography.

[Intracranial lipoma associated with partial paralysis of the homolateral oculomotor nerve diagnosed by means of computerized axial tomography]. / Lipoma intracranico associato a paralisi parcellare dell'oculomotore comune omolaterale diagnosticato con la tomografia assiale computerizzata.

The authors refer a case of lipoma of the middle cranial fossa in a 48-year-old-man, who also showed a incomplete paralysis of third omolateral cranial nerve. By the analysis of clinical symptoms and of the data in the literature, the AA. are of the opinion that the third nerve deficit they observed is due to a primary malformation of the nerve itself. The importance of radiological findings is emphasized: the stratigraphy showed sphenoid bone defects; the CT allowed the right diagnosis displaying an area of low attenuations values.

[Aortometric correlations in normal and pathological subjects]. / Correlazioni aortometriche nel normale e nel patologico.

The chest roentgenograms of 691 normal, arteriosclerotic and hypertensive patients have been reviewed for measurements of the aortic knob. There is a significant correlation between the width of the aorta and age, but no such correlation was found with the degree of hypertension. The comparison between average widths of the aorta in the 3 categories of subjects has shown its increase in arteriosclerotic and hypertensive patients.